From the Guidelines
Rosacea treatment should prioritize a combination of topical and oral medications, along with lifestyle modifications, with metronidazole 0.75% or 1% gel/cream applied twice daily being a first-line treatment option, as supported by recent studies 1.
Treatment Options
- Topical treatments: metronidazole 0.75% or 1% gel/cream applied twice daily, azelaic acid 15-20% applied twice daily, or ivermectin 1% cream applied once daily
- Oral antibiotics: doxycycline (40mg daily for anti-inflammatory effects or 100mg twice daily for antimicrobial effects) for 8-12 weeks
- Lifestyle modifications: avoiding triggers like spicy foods, alcohol, extreme temperatures, sun exposure, and stress, using gentle skincare products, non-soap cleansers, and daily broad-spectrum sunscreen
Severity-Based Treatment
- Mild to moderate rosacea: start with topical treatments
- More severe cases or those with significant inflammatory lesions: consider oral antibiotics
- Persistent facial redness: brimonidine 0.33% gel can provide temporary relief when applied once daily
Additional Therapies
- Laser or intense pulsed light therapy may help reduce visible blood vessels and redness in resistant cases
- Maintenance treatment depends on treatment modality and patient preferences, with the goal of preventing relapse and managing symptoms long-term 1
From the Research
Treatment Options for Rosacea
- Topical medications such as metronidazole, azelaic acid, and sulfacetamide/sulfur are commonly used to treat rosacea 2
- Oral antibiotics like tetracyclines and oral retinoids can also be used, either alone or in combination with topical treatments 2
- Light-based therapies, including intense pulsed light and pulsed dye laser, are effective for treating the erythemato-telangiectatic type of rosacea 2
Efficacy of Topical Treatments
- Metronidazole 1% gel and azelaic acid 15% gel have been shown to be effective in reducing inflammatory lesion counts and erythema in patients with moderate rosacea 3
- Azelaic acid has been found to be more effective than placebo in reducing symptoms of rosacea, based on participant assessments 4
- Metronidazole has also been shown to be more effective than placebo in reducing symptoms of rosacea, based on physician assessments 4
Combination Therapy
- Combination therapy, involving the use of multiple treatments, is often necessary to manage the symptoms of rosacea effectively 5
- Topical treatments can be combined with oral antibiotics or other medications to achieve better results 6